Cardiology

Question 1

What is Bisferiens Pulse a sign off (double pulse on palpation of the artery)

Answer 1

Mixed aortic valve disease

Question 2

Most common cause of infective endocarditis:
1) < 2 months post valve surgery
2) No cardiac surgery or over 2 months post cardiac surgery

Answer 2

1) Staphylococcus epidermis
2) Staphylococcus Aureus

Question 3

Optimal time to take a statin?

Answer 3

Last thing in the evening

Question 4

Patients with pulmonary arterial hypertension, who have a positive response to vasodilator testing should be treated with?

Answer 4

Calcium channel blockers (e.g. Nifedipine)

Question 5

Medical definition of eisenmengers syndrome?

Answer 5

The reversal of a left to right shunt

Question 6

In the management of stable angina, all patients should receive what combination of medication?

Answer 6

Aspirin + Statin

Question 7

What is the first line medication for management of stable angina symptoms?

Answer 7

BB or CCB

Question 8

What additional heart sound will be heard in:
1) DCM
2) HOCM

Answer 8

1) 3 (3 letters)
2) 4 (4 letters)

Question 9

First line antihypertensive for pregnancy induced hypertension?

Answer 9

Labetalol

Question 10

First cardiac enzyme marker to rise in acute MI?

Answer 10

Myoglobin

Question 11

Cardiac enzyme which is useful to look for re-infarction within 3 days of acute ischaemic event?

Answer 11

CK-MB

Question 12

Murmur: early diastolic murmur

Answer 12

Aortic Regurgitation

Question 13

Murmur: loud systolic ejection murmur

Answer 13

Aortic Stenosis

Question 14

Murmur: mid-systolic click usually accompanied by a late systolic murmur. It is more common in people with connective tissue disorders, such as Marfan syndrome.

Answer 14

Mitral Valve prolapse

Question 15

Murmur: low-pitched, rumbling, mid-diastolic murmur heard loudest over the apex. The most common cause of mitral stenosis is rheumatic fever

Answer 15

Mitral Stenosis

Question 16

What two conditions are Pulsus Paradoxus associated with?

Answer 16

1) Severe Asthma
2) Cardiac Temponade

Question 17

What 3 conditions is a collapsing pulse associated with?

Answer 17

Aortic Regurgitation
Patent ductus arteriosus
Hyperkinetic states

Question 18

Pulses alternans is associated with what condition?

Answer 18

LVF

Question 19

“Jerky Pulse” is associated with what condition?

Answer 19

Hypertrophic obstructive cardiomyopathy

Question 20

Pulmonary artery hypertension patients with negative response to vasodilator testing should be treated with?

Answer 20

Prostacyclin Analogues
Endothelin Receptor antagonists
Phosphodiesterase inhibitors

Question 21

What is the reversal agent for bleeding when on Dabigatran?

Answer 21

Idarucizumab

Question 22

Mechanism of action of thiazide diuretics which can result in hypokalaemia?

Answer 22

Increased delivery of sodium to the distal part of the convoluted tubule

Question 23

Mechanism of furosemide?

Answer 23

Inhibits the Na-K-Cl cotransporter in the thick ascending limb of the loop of henle

Question 24

What is the main ECG abnormality that you would see in Hyper Ca2+?

Answer 24

Shortening of the QTC interval

Question 25

Inherited long QT syndrome, sensorineural deafness, due to an abnormal potassium channel

Answer 25

Lervell and Lange-Nielsen syndrome

Question 26

S2 Hear sound (closure of the aortic valve followed by closure of pulmonary valve) 1) Loud 2) Revere Split 3) Widely Split 4) Fixed in the middle

Answer 26

1) Hypertension 2) LBBB, Severe Aortic Stenosis 3) RBBB, Deep Inspiration 4) Atrial septal defect

Question 27

Patients with poor dental hygiene are at risk of developing infective endocarditis from what source of bacteria?

Answer 27

Viridans Streptococci (e.g. Streptococcus sanguinis)

Question 28

A newborn is suffering from a continuous machine like murmur which subsequently is diagnosed as a PDA. What medications can promote closure of a PDA?

Answer 28

Ibuprofen OR Indomethacin

Question 29

In Cyanotic heart disorders such as transposition of great vessels, what can keep the PDA open?

Answer 29

Prostaglandins

Question 30

What is the most common cause of death (arrythmia) in patients following a myocardial infarction?

Answer 30

Ventricular Fibrillation

Question 31

What ECG feature would be suggestive of a ventricular tachycardia rather than a supreventricular tachycardia with aberrant conduction?

Answer 31

Atrioventricular dissociation

Question 32

Patient with congestive cardiac failure, oedematous despite furosemide. Key physiological changes: -Aldosterone levels -What activates renin angiotensin aldosterone system?

Answer 32

-Elevated -Reduced renal pressure identified by the Juxtaglomerular apparatus

Question 33

JVP Wave Forms: A wave C wave V wave X Descent Y Descent

Answer 33

A wave = Atrial contraction C Wave: Closure of tricuspid valve V wave = Giant in tricuspid regurgitation X Descent = Fall in atria pressure during ventricular systole Y Descent = Opening of tricuspid valve

Question 34

What receptors do Clonidine act on?

Answer 34

a-2 adrenoreceptors

Question 35

MOA of Hydralazine? -Contraindications

Answer 35

Elevates levels of cyclic GMP leading to relation of smooth muscle to a greater extent in the arterioles than the veins -SLE/IHD

Question 35

Congenital heart disease. Most common cyanotic causes: -Birth -Overall

Answer 35

-Transposition of great arteries -Tetralogy of fallot

Question 36

Congenital Heart Disease. Most common acyanotic cause

Answer 36

Ventricular Septal defect

Question 37

Ventricular Septal Defect: -Cyanotic or Acyanotic -Murmur

Answer 37

-Acyanotic -Pan Systolic

Question 38

Tetralogy of Fallot -Cyanotic or Acyanotic -4 features

Answer 38

-Cyanotic -VSD + Right ventricular hypertrophy + RVOT obstruction due to pulmonary stenosis and Overriding aorta

Question 39

Patent Ductus Arteriosus -Acyanotic or cyanotic -Where is abnormal connection -Risk factors -Features -Management to close the connection

Answer 39

-Acyanotic -Pulmonary trunk and descending aorta -Premature babies, high altitude, rubella infection in the first trimester -Left subclavivcular thrill + continuous machinery murmur -Indomethacin

Question 40

Atrial Septal Defects -Two types - Feautres

Answer 40

-Ostium Secundum and Ostium Primum -Ejection systolic murmur, fixed splitting of S2

Question 41

In atherosclerotic cardiovascular disease, foam cells play a key role, from what cell lineage are they derived?

Answer 41

Monocytes